It is recognizing that reform is a two-edged sword –
government controls and creative means of minimizing those controls.

It is a state of mind – that’s all right to try and
try again, and to fail.

It is thinking outside the box.

It is knowing there is a box – and regulations and
codes create that box.

It is acknowledging what is and what could be.

It is believing that patients are very smart people,
capable of learning what is good and bad care and acting upon that knowledge.

It is giving people the means of spending their own
money in ways they see fit.

It is looking unblinkingly at what data and science
says.

It is believing in the potential power of the robot
and the computer, but knowing limitations of both.

It is believing humans should have the power to
trump protocols and algorithms.

It is making failure acceptable.

It isknowing
wild and crazy individuals have wild and crazy ideas that are worth a try, and that organizations can foster these
individuals by giving them space to dream.

It is being aware rules, regulations, and
bureaucracy can dry up creativity.

It is about getting real and seeing that capital is
the fuel for applying imagination solutions.

It is about looking at wider world and seeing what
drives innovation – GPS, IPhones, social media, and virtual information – and
applying and connecting that knowledge to the health care world.

Finally, it is about communicating your ideas and
ideas of others on innovation to your fellow caregivers.

That is what I try to do with the following
proposal.

Proposal

Dear Fellow Health Care Innovator.

In 2005, I wrote a book
Voices of Health Reform, Interviews of 45
National Health Care Stakeholders at Work. In 2007, Jones and Bartlett
published my book Innovation-Driven
Health Care: 34 Key Concepts for Transformation.That same year, I started the Medinnovation
Blog.Today, 2700 blog posts later, I have
700 readers each day, 789 yesterday.Over 125 of my blogs have been on innovation.I am working on my latest book, Innovation and Health Reform, which will be availablein several months and will contain 100 of my
blogs on innovation.

New
Venture and a Proposal

I have embarked on a new venture:Interviews
with Health CareInnovators,of whom you are one.

My proposal is this:

For an introductory price to be negotiated,I will personallyinterview you for your ideas of innovation
and what your company is doing to promote health care innovation.I will then publish your interview on my
blog, along with an ad approved by your organization, which will appear as an
integral part of the blog post.You may
then take my blog post and distribute it to your customer base and to potential
clients.I will also send you an
autograph copy of my new book Innovation
and Health Reform.

My intent is to develop a forumfor innovation thought leaders in which you
can express yourself in your own words.

If you have any interest , let me knowat 1-860-395-1501 or rreece1500@aol.com, so we
can schedule time for an interview.

Tuesday, February 26, 2013

Age
of Discontinuity and Disruptive Innovation Converging in Organizations with Wherewithal That Understand Markets, Consumers, and Physicians

Everything
That Rises Must Converge

Title
of 1965 story by Flannery O’Connor (1925-1964)

For hospitals and doctors, the age of discontinuity
and disruptive innovation has
arrived in the form of organizations with the wherewithal that understand the needs of patients and doctors.Things will never be the same
again once these organizations gain traction.

This is because of the rise of these economic and
social forces.

·Soaring health care costs

·Demand for cost containment by the
public,employers, and patients

·Health reform,government and private

·Digital revolution,informationaland technological

·Hospitals and integrated health
organizations as replacementsfor
doctors’ offices and coordinators of care

·Nurse practitioners,physician assistants, and home care
caregivers

·Physician fragility,fragmentation, and role reallocation

These forces are converging into organizations that
have the credibility – and the administrative, technological, capital, and
marketing resources, and innovative capacity - to do what needs to be done.

Peter Drucker (1909-2006), the father of modern
management and social philosopher, spotted this converge 45 years ago in his
book, The Age of Discontinuity.

Every single social task
of major impact . . . is increasingly entrusted to institutions which are
organized for perpetuity and which are managed by professionals, whether they
are called ‘managers,’ ‘administrators,’ or ‘executives.'

Drucker
also noted that government, because of its distance from the point of care, its
bureaucratic impediments, and its inability to innovate, is not up to the task of
reforming health care.

The best we get from
government in the social welfare states is administrative incompetence. Every
country reports the same confusion, the same lack of performance, the same
proliferation of agencies and programs, of forms, and the same triumph of
accounting rules over results.

Into the
health reform arena has stepped Clayton M. Christensen, a Harvard Business
School professor, who explains disruptive innovation, or disruptive
technologies this way.

Disruption enables less-skilled people to do more sophisticated
things. Disruptive innovation enables a large population of less-skilled
population to do things in a more convenient, lower-cost setting, which
historically could only be done by specialists in a less convenient setting.

Like Drucker,
Christensen is skeptical government can effectively do health reform.In last week’s February 16 Wall Street Journal, “The Coming
Failure of Accountable Care,” Christensen and colleagues doubted that
government efforts to bring down costs through Accountable Care Organizations
would succeed. They say Accountable Care Organizations, which are nothing more
or less than updated HMOs. will fail because of flawed assumptions about doctor
and patient behavior.The conclude” “what
ACOs most assuredly will not do is deliver
the disruptive innovation that the U.S. Health care system urgently needs.”

In essence,Obamacare throws a bunch of ideas in the form of demonstration projects stretched out over the next 3 to 5
years on the wall to see if any of them stick. These include ACOs, medica homes, bundled payments,teams delivering care in patients’ homes,
reducing hospital readmissions,pay for performance based on evidence and outcomes
,paying less if health care records are
not adopted and if “meaningful use” criteria are not adopted, and enforcing their ideas through Independent Payment Advisory Board .These ideas are disruptive but they are not
necessarily innovative. I am doubtful that iron fist of government will make them stick
.Only innovative organizations that
understand markets, consumer. and physician can do that.

Tweet:Ideas to lower costs
and make health care better are converging in innovative organizations that
understand markets, consumers, and physicians.

There
are very few human beings who receive the truth , complete and staggering, by
instant illumination. Most of them acquire it by fragment, on successive
development, cellularly, like a laboratory mosaic.

Anais
Nin (1903-1977), The Diary of Anais Nin

Live
in fragments no longer.

Edward
Morgan Forster (1879-1970), Howards End

Freedom
is fragile and must be protected.

Germaine
Greer (born 1939)

Recently Kurt Mosley of Merritt Hawkins AMN
Heathcare, sent me a 64 slide presentation he is giving before hospitals,physician organizations, and healthcare
management associations across the country.

In his
talk,Mosley describes the fragility
and fragmentation of physicians,as they
try to respond to health reform pressures, and how hospitals and doctors might react to
lessen these pressures.

Hospital physician relations are a fragile thing.

As a hospital CEO once explained,“You can’t live with physicians and you can't
live without them.”

Under reform, the same is now true of
physicians.They can’t live with
hospitals.Indeed, they often compete with
hospitals.Increasingly, physicians can’t live without hospitals .Physicians simply don’t have the
administrative,technological, capital,
and marketing resources to deal with the regulations,rules,demands, and mandates of Obamacare or of similar pressures of managed care and health plans.

In a sense,hospitals,or the so-called
integrated health care organizations with hospitals at their core,are replacing doctors’ offices. This is understandable when you consider in any given city in the U.S.hospitals are the biggest business in town,are the largest employer, have the most political clout, and are the
best equipped to deal with administrative demands of Obamacare.

That is why physicians are flocking to hospitals for
employment,why hospitals are growing to
counteract Obamacare, why dominant hospitals can negotiate the best contracts
with hospitals,and why hospitals may
own 75% of physician practices by 2020.

Mosley and Merritt Hawkins know this realities.

As a large
physician recruiting firm, Merrit Hawkins knows:

· More and more of their physician recruiting business comes from
hospitals.

·
The physician
union is fragile and fragmented , with just 50% of physicians saying they will practice
as they do now over the next three years,with the other 50% fragmenting becoming hospital employees, retiring,not accepting new Medicare and Medicaid
patients, working part-time, working locum tenens or in concierge practices, or
seeking employment either in or outside of medicine.

The end result may be a
physician shortage of unprecedented magnitude
with 83, 000 physician assistants and 155,000 nurse practitioners try to
pick up the slack to relieve physician shortages.

This talk spells out the options of “realignment, “ “collaboration,
“ and “cooperation between hospitals and physicians, both of whom face
decreased funding and reimbursement under Obamacare for the next ten years.

Tweet:Over
the next 10 years,hospitals and
physicians must cooperate and innovate to mitigate the effects of Obamacare to contain costs.

Sunday, February 24, 2013

Imagining
Being a Young and Restless Physician

A
tough, but nervous, tenacious restless race; materially ambitious, but prone to
introspection, subject to waves of religious emotions... A race that typical member
is torn between a passion for righteousness and desire to get on in the world.

Samuel
Eliot Morison (1887-1976)

“You can actually make a lot of money and do a lot
of good in the world.”

Andrew
Goldman, Interview with Peter Henry, dean or N.Y.U’s Stern School of
Business,February 24, 2013, New York Times Sunday Magazine

I awoke this morning imagining what I would think as
a young medical student physician about to select a residency knowing what I
know now. In my imagining, I was 25
years old and married to a fellow medial student. Together, we were $250,000 in debt.

I would be torn whether to become a primary care physician
or a specialist.Most of my mentors on
the medical school faculty have been specialists, but I would know that

·The United States desperately needs
primary care physicians, they do a world of good, it would be the righteous
thing to do, and they are in short
supply, particularly in rural America and in inner cities.

·Foreign
medical school graduates and osteopaths are a growing proportion of primary
care physicians.

·Most of my classmates envision working
for hospitals or large medical groups because starting a practice on your own
is difficult, and it is impractical to practice solo or to get financing to do
so.

·Specialists
make 2 to 3 times what specialists make, but that Obamacare plantsto raise primary care doctors by 10% a year over
the next 4 years while cutting specialists’ pay.

·Getting
residences is competitive for the ROAD (Radiology, Orthopedics or
Ophthalmology, Anesthesiology, and Dermatology), all of whom have shorter work
hours, higher incomes, and more balanced life styles.

·Working for a salary for a hospital or a
group was probably my destiny, and I would be interested in a 40 hour work week,
fringe benefits, health care premiums, payment of my medical school debt, and
malpractice premiums.

·I would be aware the end-game of health
reform was still highly uncertain and my ultimate fate after completing 3 to 5
years of training was unknown as well as where I would fit into the system.

But, given economic conditions for the economy, with
a huge national debt and high unemployment, I was not unhappy in my decision to
become a doctor.After all, because of
the doctor shortage and the rise of health care as the leading economic growth
sector, I was virtually assured of gainful employment.

That was more than I could say for many of my
college classmates.Some had gone to law
school. Half of them were unemployed 6 months after receiving their law
degrees.Even those who received their MBAs
were having trouble finding work.Both
of which might explain why those seeking admissions to law school and business
schools had dropped precipitously y over the last 4 years.The information technology sector was, but the financial sector wasn’t going anywhere.At least, my wife and I would have the means of paying
off our college, medical school, and post-graduate training debts.All I wanted was to do good and to do well,
and I still thought I could do both by becoming a doctor.

Tweet:Knowing what I know now, becoming a
physician is positive thing, especially
when one factors in conditions of the overall economy.

If
it’s flipping hamburgers at McDonald’s, be the best hamburger flipper in the
world, whatever it is you have to do to master your craft.

Snoop
Dog

I hate to be flippant, I really do, but Obamacare
has a problem.

The law requires firms with 50 or more employees to
offer comprehensive health coverage to those who work more than 30 hours a week.If the firm reaches or exceeds the magic 50
and does not cover them, it faces a $40,000 penalty.

This comes down to a $2,000 tax for each hire over
50.The fine goes to $60,000 over 60
workers.This is tough to do if you are
a franchisee or owner of a fast-food hamburger business with average profits of
$50,000 to $100,000 and average margins of 3.5%.

How are McDonald’s
, Wendy’s, and Burger King coping with the new rule, soon to take effect in
2014?They are still hiring workers to
flip burgers, but only for 29 hours a week, barely time enough to master their
craft.

And the firms are talking to each other, or so it is said, about
sharing part-time workers, thereby dodging the 50 worker Obamacare rule and
staying in business rather than going out of business.

And what are workers doing?They are flipping part-time jobs, rather than
working full-time.They may work the
morning shift at McDonald’s, then go to a nearby Burger King or Wendy’sto create a full-time work week in order to
pay their bills, includinghealth insurance
that the Obamacare individual mandate requires them to buy.

The end result is that employers are stuck with
hiring part-time workers,and workers are
stuck with part-time jobs.

To conclude:

Somehow
Obamacare’s full-time worker health coverage rule,

Requiring
firms to pay for health plans in the 50 or over pool,

For
incentives to owners, this seems perverse,

For
workers, this seems economically in reverse,

and
to full-timer workers, job flip-floppers, and preparers of Big MacWhoppers,

It
all seems to be unfair and even cruel.

Tweet: Obamacare requires firms with 50 or more workers to provide provide them with halth insurances, whih fast-food firms say they cannot afford.

For the
last ten years, I have been on the board of medical advisors for a New York
City- based publishing company Castle Connolly Limited.Among its activities, Castle Connolly publishes
an annual book America’s Top Doctors. Through
nominating process, Castle Connolly identifies 3000 or so of these doctors and
publishes their names in its national and regional publications

Castle
Connolly also sponsors an annual National Physician of the Year Awards evening,
akin to an Academy Awards,for physicians.

Sterling Williams, M.S., M.D., Ph.D.
Vice President of Education, American College of Obstetricians &
Gynecologists
Clinical Professor of Obstetrics & Gynecology, George Washington University
Medical School

It occurred
to me a similar search might be conducted for PhysicianLeaders of the year. A dearth of
physicianleadership exists.When the American Medical Association backed
Obamacare,it created a leadership
vacuum.Tens of thousands of physicians
resigned from the AMA. Why? Physicians felt powerless and leaderless. Though national
surveys, the Physicians Foundation (physiciansfoundation.org) has documented
this concern about lack of leadership.

Physicians
are angry because Obamacare systematically decreases their reimbursements, attacks the fee-for-service reimbursement system,hassles them with burdensome regulations, increases practice expenses through mandatory
EHRs and electronic prescribing, forces them into accountable care
organizations,creates physician shortages,dries up access to physicians,and drives up cost of care.

In any
event,physicians are looking for
physician leadership to lead them out of the health reform morass and abyss.

Friday, February 22, 2013

Why
the Medical-Industrial Complex Is Killing Us

I
got the idea for this article when I was visiting Rice University last year. As
I was leaving the campus, which is just outside the central business district
of Houston, I noticed a group of glass skyscrapers about a mile away lighting
up the evening sky. The scene looked like Dubai. I was looking at the Texas
Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and
related medical facilities, of which MD Anderson is the lead brand name.
Medicine had obviously become a huge business. In fact, of Houston’s top 10
employers, five are hospitals, including MD Anderson with 19,000 employees;
three, led by ExxonMobil with 14,000 employees, are energy companies. How did
that happen, I wondered. Where’s all that money coming from? And where is it
going? I have spent the past seven months trying to find out by analyzing a
variety of bills from hospitals like MD Anderson, doctors, drug companies and
every other player in the American health care ecosystem.

Frankly, I was astonished when I read Steven
Brill’s article on the use and abuse of chargemaster accounts to bill patients
in U.S. hospitals.

To begin with, the
story is over 24,000 words long. That’s long enough for a book.

Secondly, it is
full of horror stories about patients being overbilled compared to Medicare
rates.

Thirdly,it is critical of hospital
administrators,who run multibillion
institutions,that are the major
employers in many American cities.

Fourthly,
there seems to be no accountability, no rhyme or reason, for the excessive
bills and no attempts to fix them.

Fifthly , it is harsh
in its criticism of America’s hospitals’ charges, a major driver of our health
costs, which exceed those of other nations
by at least 27%.

Brill writes:

“When
you crunch data compiled by McKinsey and other researchers, the big picture
looks like this: We’re likely to spend $2.8 trillion this year on health care.
That $2.8 trillion is likely to be $750 billion, or 27%, more than we would
spend if we spent the same per capita as other developed countries, even after
adjusting for the relatively high per capita income in the U.S. vs. those other
countries. Of the total $2.8 trillion that will be spent on health care, about
$800 billion will be paid by the federal government through the Medicare
insurance program for the disabled and those 65 and older and the Medicaid
program, which provides care for the poor. That $800 billion, which keeps
rising far faster than inflation and the gross domestic product, is what’s
driving the federal deficit. The other $2 trillion will be paid mostly by
private health-insurance companies and individuals who have no insurance or who
will pay some portion of the bills covered by their insurance. This is what’s
increasingly burdening businesses that pay for their employees’ health
insurance and forcing individuals to pay so much in out-of-pocket expenses.

Steven
BrillI asked myself – Who is
Steven Brill?

Here's what Wikipedia has to say.

“Steven
Brill (born August 22, 1950 in Queens, New York)] is the founder of CourtTV and American Lawyer magazine. His most recent venture is
Journalism Online, which he sold to RR Donnelley in 2011 for a reported $45 million and now has
more than 400 publications using its Press+ service to charge for digital
content. He also founded Verified Identity Pass, Inc., a New York-based company
that operated the Clear airport security
fast-pass, a pre-cursor to the current Federal Trusted Traveler program. In
1998, Brill created Brill's Content, a widely-acclaimed magazine with a
critical eye to the media. He also launched Contentville.com, which was to be a
clearinghouse for the buying and selling of web text, news, and info of all
sorts. In addition to writing a column for Newsweek, he has written magazine articles for The New Yorker,The New York Times Sunday Magazine,Harpers and TIME. He is the author of
The Teamsters (1978), After: How America Confronted the September
12th Era (2003) and Class Warfare: Inside the Fight to Fix
America's Schools (2011).

This is a very entrepreneurial guy
who knows how to turn a buck.

I have no criticism of his research
which is well documented and based onscrutiny of hospital bills. Nor
do I disagree with some of his conclusions – institute tort reform, outlaw
chargemaster accounts, scrutinize and limit non-doctor executive incoms or this concluding paragraph,

“Over
the past few decades, we’ve enriched the labs, drug companies, medical device
makers, hospital administrators and purveyors of CT scans, MRIs, canes and
wheelchairs. Meanwhile, we’ve squeezed the doctors who don’t own their own
clinics, don’t work as drug or device consultants or don’t otherwise game a
system that is so gameable. And of course, we’ve squeezed everyone outside the
system who gets stuck with the bills.

Tweet:In any given city, hospitals are often the
biggest business in town,the largest
employer, and the most profitable business enterprise.

The Health Reform Maze

Buy the Book

Book Description: In this first book in a series of four, Richard L. Reece, MD. provides a unique view of the roll out, and run up, of the Affordable Care Act. Reece shows in this book the progress and facets of ObamaCare's marketers and messengers, as the day approached for the launch of health insurance exchanges - the single most public and problematic portion of the new law. This is a must read for anyone who wants to chronicle this attempt to organize more than one-sixth of the U.S. economy by adding layers of federal government control and regulations.

Reece has been writing about U.S. health care for more than 45 years. His knowledge and experience, added to his keen intellect and gift of subtle humor, make this book a valuable part of anyone's collection.